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HomeMy WebLinkAboutJACOBS INVESTMENTS LLC COLORADO BORING CO NORTHERN - INSURANCE CERTIFICATEIernlNv-n1 I PRFWITT ,acoRO CERTIFICATE OF LIABILITY INSURANCE DAT1O/YVVY( 7/30/230/201 9 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER CONTACT NAME, PFS Insurance Group P (aONNo Et): ( ) 635-9400 Fac, No r(970 fi35-9401 ) 4848 Thompson Parkway Suite 200 Johnstown, CO 80534 E- ' info@mypfsinsurance.com INSURERS AFFORDING COVERAGE NAIC III INSURER A: Valley Forge Insurance 20508 INSURED INSURER B : Continental Insurance Company 35289 INSURER C : Plnnacol Assurance CO 41190 Jacobs Investments, LLC Colorado Boring CO; Northern Lights Leasing, LLC 3813 Canal Drive INSURER D: INSURER E : Fort Collins, CO 80524 INSURER F : rnvcoar-cc CERT!9CATE Nlnssat=R, RFVIRION NIIMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX OCCUR Mid: Add'[ Insured 16078887283 8H/2019 I EACH OCCURRENCE 8N 12020 DAMAGE TO MED EXP (Any oneperson) P ERSONAL a ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ 1,000,000 $ 300+000 X 10,000 X Blanket Waiver $ 1,000,000 GEWL AGGREGATE LIMIT APPLIES PER: POLICY X jP& El LOC OTHER: $ 2,000,000 $ 2,000,000 A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AURTEO�S ONLY AUUTNOSSWNEpBODILY UTOS ONLY X AUTOS ONLY Add'I Insd X Blanket Waiver 1xx 6078887297 8/1/2019 8/1/2020 BINED (Ea acciden SINGLE LIMIT $ 1,000,000 BODILY INJURY Per erson $ INJURY Per accident $ a0�� nI AMAGE $Blanket B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 6078887302 8/1/2019 8/1/2020 EACH OCCURRENCE $ 8,000,000 AGGREGATE $ 8,000,000 DED X RETENTION $ 10,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE Y� 'QQF�FICER/MEMg R EXCLUDED? (xlantlatory IIt NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 211616 ' BM/2019 8/1/2020 X I PERTLI OTH- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1+000,000 E.DI EA E - POLICY LIMIT 1 000 000 ' ' A ',Leased/Rented Equip 16078887283 8/1/2019 8/1/2020 $6,000 Deductible 300,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached If more space Is required) Re: Project Harmony Duct Bank Timberline Sub to Ziegler. If required by written contract or written agreement the City of Fort Collins is included as additional insured for ongoing operations under General Liability. Special Form - Replacement Cost - $2,500 deductible - Intallation Floater regarding 05" Bore Gard Pime Conduit Material. Limit $336.000 on job site/in transiVtemporaty location. City of Fort Collins Financial Services P.O. Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD